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APPL{CAT10� FOR CONSTRUCT .JN PERMIT everett <br /> TO BE COMPLETED IN INK—PLEASE PRINT � <br /> fhe Evergreen <br /> CITY OF <br /> everett I HEATING SYSTEM• �GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT � <br /> 259-8810 <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL - PLUAi81NG SIGN <br /> pWNER MAILADDRES: CITV ZIP PMONE <br /> � ' � <br /> �Gu/J7��'S CF�t�ir�i�H ���c- r�::rr�rr Et t-"x'c-7t 9�'<<al ov Sy 3/ / <br /> TENANT <br /> MAILAOORESS CITY ZIP PHONE <br /> Spw,t <br /> ARCMITECT OR�ESIGNER <br /> MAILADDRE55 GTY 21P PHOYE <br /> l $ CVcPE fi °vd�iG� �- �% .>'/C'� <br /> 7h��/R�,HnN �t,1N��rr /toz k' 7t 4 <br /> GENERALCONTRACTOfi <br /> MAILADDRE55 CITV ZIP PHONE LiCENSEM <br /> NF�TA�� KE���c-K i �v oA <br /> l 'IJ L��-lC.J Z�p PMONE IICERSE M <br /> MECHANICALCONTRAGTOR MAILADOBE55 ��N <br /> PLUMBINGCONTflACTOF MAILADDRESS <br /> CITV ZIP PHONE LIGENSE• <br /> CLASS OF WORK <br /> ❑ NEW [ i ADDITION .�ALTERATION _1 REPAIR .�' DEA�OLITION �.��. WOODSTOVEIFRPLINSERT ��.: BUII.DINGRELOCATION <br /> CONTACT PERSON AND PHONE NO. <br /> �IlD/D��' .Joez N�c-�,��- �/tF!�y/=r_is:ynl �i'�Hil�cTs' zS93/[•I <br /> CONTRACTPRICE OF WORN .— <br /> DESCRIBEWQRKANDSOUAREFOOTAGEINVOLVED �� ��rr �� ��±L7{ <br /> ,�curv�tn.-� cr r 2e'<�: sr- ? <br /> PROPOSEDUSEOFBUILDING I HL=REBY CERTIFY THAT I HAVE AEAD APID EXAMINED THIS <br /> � / F��., . '� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �e�A oE c PT oNOF PROPERTV ISHOWN BELOW OF ARACH FOURCOPIES� PROVISIONS OF LAWS AND OFDINANCES GOVEiRNING THIS TYPE OF <br /> `�}r �� WORK WILL BE COMPLETED WITH WHETHER �tPECIFIED HEREIN OR <br /> �oT v e�ocK G G� oF P NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OFi CANCEL THE ?ROVISIONS OF ANY <br /> ����- OTHER STATE OR LOCAL LAW REGULATING C(�NSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AIA AUTHORIZED BY THE <br /> QWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPL'V WITH THE STATE <br /> CONTRACTOFS LAW 18.27 RCW AND 296200�VAC. <br /> SIGNATUREOFCONTRACT��ORQF�AUTHOy1ZEDAGENT DRTE <br /> � �i <br /> �—����-� <br /> G�,/C ,L z-----,_, v 3 '�� <br /> PRQIECT ADDREES ,�+'�� qpPCI�NTS GTV BUSINESS LICENSE NO.AND BUSINES511AME <br /> ?Q��� LO/�T�/'/? �'��c(� S�R MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> AI�AIHNDLG UNITS—H.P. ' <br /> WATER CLOSET(TOILET) ' � <br /> � F9RCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB ' ' <br /> LAVATORY(WASH BASIN) i UNIT HEATERS-6.T.U. M _ <br /> � CLOTHES DRYERS ' <br /> SHOWER <br /> KITCHEN SINK&DISP � VENTILATION FAN — <br /> DISHWASHER � RANGE HnOD ' <br /> LAUNDRYTRAY ; WATER HEATER � <br /> , WOOD STOVE ' <br /> CLOTHES WASHER � <br /> � METAL FIREPLACE 8 CHI Y <br /> URINAL � ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> � HEAT PUMP <br /> FIOOR DRAIN � <br /> BACKFLOW P VENTERS ; GAS PIPING --- <br /> � EXHAU FAN ' — <br /> R00�D NS—RAINLEADERS � <br /> � <br /> SINR RVICE—BAR,ETC.) ' <br /> � <br /> � <br /> � — <br /> � � <br /> � � <br /> SUB TOTAL $ SUB TOThL $ ' <br /> PERMIT $ PERMIT 5 � _ <br /> TOTAL FEE S ' TOTAL F[E 5 ' <br /> FOR OFFICE USE ONLY: FEE aeceiarNo. <br /> pLANLHECKNUMBEF <br /> FRONT SE�N FEPR SETBACH SIOE SETBRGN �/ � �O � � y� Y3 .y �7 6 S' <br /> a, i�� <br /> �N I�� FEE <br /> USEZONE LOTAREA M M <br /> vncarit sire FEES VALUATfON <br /> g-3 �5� 7! _ BUILDING ��n UW � ', � 'r� <br /> TYPEOFCUNrS;A/LOW/BlE TYFEOFGONSiALTUAL aCcuasNw NoO=CNFIun,uHrtS i <br /> caouP � pLUM81NG ' <br /> �j �✓ B-'2 � <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHHNICAL <br /> i <br /> a$OZ ��•�. T•I. — ADDITIONALPLANCHECK ' <br /> OCCUPANCY LOAD FIRE SPpNKlERS HEO'D HEIGHT LIMITATION � <br /> r ��✓O OTHER __� <br /> 6 <br /> REnSo FOR$PR�NKLERS STATE BUILDING SUF7CHARGE ' �u <br /> i <br /> INTANEBV PLA APPROVEDBY CITVOFEVERETT ;,ueucwoaKs � <br /> � LOCALSALES � ' <br /> � f�� TAX COUE IS 3105 TOTAL G J 9 � a� <br />